Rachael's first two birth stories are on this site. Her first baby, Verity, was born in hospital, while her second, Archie, arrived by home waterbirth weighing 9lb 4oz. However, with her third baby, Rachael decided to transfer to hospital after her baby passed meconium (its first bowel movement - a possible sign of distress)when her waters broke, and she was not happy with the way her labour was progressing...
Jude Parrish, born 30.05.04 at 3.06pm...
This pregnancy rushed past amazingly quickly; as usual I felt nauseous 24 hours a day for the first 16 weeks or so, but that was reassuring as I had a pretty major bleed at about 11 weeks, just at the point when you start to feel confident things are going ok. I had actually contemplated having a totally scan-free pregnancy, but the bleeding stopped those plans as I was desperate to know what had caused it, not that I ever really did find out. The sonographers thought it was either a subchorionic haematoma, or a twin pregnancy that didn't progress - anyway I was just so glad to still be pregnant after a month of bleeding that I didn't care about feeling sick or looking awful! I booked with an independent midwife again but a different one to last time as we were moving house and out of the catchment area of my previous mw. As soon as I booked with Lynn (Walcott) I felt really happy and confident with her; she was exactly what I was looking for and I can't praise her enough!
I had a couple of months in the middle in which I felt brilliant and then from about 32/33 weeks started feeling pretty awful - headaches, totally exhausted, very negative about the whole pregnancy, starting to have feelings that things might not work out right, all of which I discussed with Lynn and we put down to being very British and thinking I wasn't entitled to more than one 'perfect lovely homebirth' and that something had to go wrong. However it was a very hard pregnancy; I felt drained both physically and mentally and realised that my first two pregnancies had been really easy.
I had an instinctive feeling this pg wasn't going to go full term, even going so far as to change my pool booking so it arrived a week earlier than normal and ranting at the woman in Boots who wouldn't give me my TENS machine until I was exactly 37 weeks!
The last couple of days before things started to happen, I was feeling a lot more niggly sensations and tightenings and joked that the baby was going to arrive on bank holiday weekend, just like the last one, because I had a nice relaxing weekend planned. I went for 2 mile walk on the Thursday to try and get the head moving down as the baby was in a good LOA position but not really engaged, and was feeling better than I had done in ages. Woke up on Friday with a suspicion that something was going to happen, which must have been written on my face because a couple of mums stopped me outside school and said they didn't think I'd have long to go as I looked ready. I felt a definite 'clunk' as the baby moved down at one point in the day, which I thought was a good sign. I spent the afternoon in my friend's garden relaxing and having a couple of glasses of wine while our children played, then came home to enjoy peace and quiet while Keith went out for a drink with friends - as he left I joked 'that's ok, off you go out drinking while I give birth on my own...'!
I had a bath before bed with lavender to try and relax as I was feeling sore and tired, and woke up to go to the loo at 2.15am. I coughed and felt a ping - my waters had gone. Went into the loo and there was only a dribble coming out, less than my last two which were hindwater leaks, but I thought I'd better be good and try and collect a bit to make sure it was clear. It wasn't - it was brown, with what looked suspiciously like bits of meconium in it. I felt a sinking feeling, went through, woke Keith and told him to start filling the pool, hoping it was just old meconium and nothing to worry about. I pottered about, eating a banana and getting things organised before calling Lynn at about 3.45 to let her know what had happened. She suggested that old meconium in a pre term baby (38+5)wasn't ideal and that we could consider going and having a CTG to check on the baby - left it with us to discuss it. I still felt fairly sure things were okay, could feel the baby moving and felt instinctively that home was still the best place to be so left things as they were.
At 5.30am, I felt a small gush of fluid and realised I'd better call Lynn as this time it was definitely more meconium, and looked greenish. I was desperate to avoid going into my local hospital and as I wasn't contracting it seemed reasonable to travel that bit further to the John Ratcliffe in Oxford (40 mins away) where Lynn is able to get a contract and work within the hospital. Once we started getting things organised, arranging for the children to spend the day with friends of ours, I realised I was having fairly strong contractions every 10 mins and decided that I didn't relish the thought of two 40 min car journeys in increasingly strong labour, so called Lynn who said she'd come to the house where we could evaluate things. Everything was very calm at this point, thanks to both Lynn's measured approach and Keith who was very laid back about everything as well, so while it might sound a bit fraught, as far as I was concerned at this point everything was still on for a home birth and I felt fine.
Lynn arrived at 7.40 and said I had a good labouring look - flushed - and was pleased to hear I'd been eating crumpets and bananas for fuel! We had a chat about the various options available to us and what they'd mean. A CTG in hospital to assess the baby would in my mind have led to admission, particularly at our local hospital and the thought of turning up there with no NHS notes and an independent midwife was not a pleasant one. Lynn also explained that it would be standard policy having seen meconium in the waters to have a paediatrician present for the birth, something I was not very keen on. I felt confident that the baby was fine and Lynn listened in with the doppler, finding the baby was moving well, reacting and with a variable heart rate. Contractions were about 1:8 at this point, still mild enough that I could chat away through them and so Lynn and I just chatted and she occasionally monitored the heart rate to make sure things were still fine. After a couple of hours she left, telling me to call if I had any concerns and I felt fairly sure that things would progress in a similar manner to my last labour and that she'd be back mid-afternoon.
We moved the children to another friend for the afternoon and I relaxed in a bath with some clary sage, vaguely aware that the contractions were slowing but still not concerned. We went for a walk which produced a few stronger contractions and then went on to the garden centre, which had pushed me over into active labour the last time! We took the children home, put them to bed and pottered around - still having sporadic contractions but certainly not regular and not increasing in intensity at all. Eventually I decided to go for a walk in the rain at 10pm to see if I could get things moving but by then nothing at all was happening. Getting a bit worried, I came home and lay on the bed to have a little talk with the baby about what was happening - I had a sudden feeling of fear because I couldn't remember when I'd last felt movement, but then he wriggled around as if to reassure me. I called Lynn to let her know that nothing at all was happening; she suggested I have a relaxing bath and go to bed and that I'd wake up in labour.
At 1.50 I woke up realising I'd been dreaming about contractions and that they were in fact real and quite a bit stronger but coming every 6-7 minutes. I left Keith sleeping, came downstairs, topped up the pool and lit some candles. I chose some music, feeling certain this was it, and stood and rocked through a few more contractions before calling Lynn at 3am to let her know things were happening. Since the initial loss of a bit of fluid, there hadn't really been much at all but finally a little tiny bit more came out but pinkish this time rather than stained.
By the time Lynn arrived at about 4am, the contractions had slowed right down again and I was starting to worry about the children waking so I texted my neighbour and arranged for the children to go straight over when they woke up. Lynn had a quick feel of the baby and told me that she was a bit concerned that now things had moved down a bit it felt like the head might be a bottom, something which had niggled at me for a few weeks - the fresh meconium would make sense in that case. What she said she could feel was a deeply engaged head or bottom, but that if it was a head, the shoulder didn't feel obviously like a shoulder and the bottom was incredibly firm for a bottom.
Obviously a quick internal would have ruled that out, but of course it wasn't that simple - at my 20 week scan the placenta was noted as anterior and low, and after discussing it with Lynn and Keith we'd decided against a 34 week scan to confirm the position. I'd had no bleeding and there was no reason to believe it was still low, but we agreed that doing an internal at this stage wouldn't be wise as this labour wasn't really progressing as one would expect, so the placenta issue had suddenly re-emerged - could it be blocking the way and stopping the progress of labour?
We had the choice of leaving things as they were, going into labour ward and having a quick ultrasound to check the position of the baby, or doing a gentle internal exam at home. Lynn said that if the baby was breech, it was a fairly typical non-progressing breech - by this point contractions had again tailed off to nothing.. We were all fairly sure that we'd have to transfer at this point. I was still desperate to avoid my local hospital and so Lynn called the Supervisor of Midwives at the John Radcliffe (who was in bed, not surprising as it was 5.30am) and they had a chat about the situation. I knew that if this was a breech which wasn't progressing we were looking at a caesarian which was terrifying. We discussed what would happen if we got there, the baby wasn't breech and the placenta wasn't obstructing the cervix - going into hospital would mean dealing with their policies on 'prolonged' rupture of membranes (in their terms, anything over 18 hours - pretty far removed from NICE's 96 hour recommendation...) and on meconium staining. That would of course mean antibiotics and a drip of syntocinon to induce labour. Normally I'd have run screaming at the thought but as we all agreed, this labour wasn't going anywhere at all for some reason and we'd had a couple of incidents of fresh meconium so something was needing to happen to get this baby out.
Keith got the children up and ready while I pottered about, organising a bag (interestingly this time I'd actually felt an urge at about 33 weeks to gather together some toiletries and things in a bag just in case, which I hadn't felt necessary with my previous home birth) and having a shower. I wasn't having contractions at all by this point but strapped on the TENS machine just in case something happened on the journey into hospital. My mum called from France, concerned because she'd heard nothing since the 'I'm in labour' text of the previous day, and I had a bit of a cry to her on the phone then spoke to my best friend who had ended up with a c/s for a breech a year ago and asked her for some advice on how to manage afterwards. Considering I was facing up to my biggest fear I think I coped a lot better than I would have expected - I'd have imagined myself in hysterics in a corner somewhere. Lynn came upstairs and was lovely, asking how I was feeling and talking me through what might happen, as well as telling me that if I ended up with a general anaesthetic she'd make sure that the baby was fully breastfed, which was my main concern.
We dropped the children off with my friend and drove to Oxford, listening to the REM cd I'd chosen for labour. I fell asleep for about 25 minutes, woke up and started crying. I was so scared, terrified about what would happen to me and terrified for my children in case something happened when I was in theatre. By the time we arrived I was reasonably composed and we met Lynn in the gorgeous sunshine and trooped in together.
After a little while we were taken up to what looked to me like a classroom! Shiny hard lino floor, bright lights, huge windows looking out onto the car park and a bed slap bang in the middle. I looked at Lynn in horror and said 'this isn't a labour room is it?'. I couldn't believe that people would choose to give birth somewhere so stark and uncomfortable - with my first, I'd given birth in hospital but it was night time and the curtains were drawn which I think made it seem a little bit warmer and less clinical. Ironically after my second was born I remember saying I was so confident in my body that I could give birth in a cupboard - didn't really want to try the theory out though!
A midwife, L, appeared, and Lynn and I explained what had been (not) happening. She suggested doing an internal exam to assess whether we were dealing with a breech. I asked why she wasn't just going to do an ultrasound (how bizarre when I think of it now that I was asking for a scan rather than relying on the skills of a midwife! I blame it on a moment of madness) and she explained that doing an u/s would involve bringing in the doctor and him poking around! Lynn and I looked at each other and I said 'oh good, she's like us!' and L laughed, saying she liked to keep them out of the way as much as possible. She did a quick internal exam and said 'well, that's a head and you're about 2cm dilated I'd say'. I'd been thinking 'if you tell me I'm 2cm dilated I'll scream'!
So there we were, with plan B in action - labour not established, baby passed/passing meconium but head down. We had already discussed what would be on offer at the JR and all things considered, agreed to a drip of antibiotics (although I have to say that the mega dose they give is worryingly high - Lynn said the loading dose was the equivalent of a week long course) and induction with syntocinon. On being told that it would be normal to administer another lot of antibs 4 hours later, I thought to myself 'well, I'd better get this baby out before then'. I was feeling fine about it all considering, although I kept looking around the room and saying 'I can't believe people would CHOOSE to come here when they could have all their own things around them'.
L then tried to put the venflon in my hand but as I predicted had trouble - the blood just wouldn't flow. I'm so scared of needles and hospitals that I've never been any good with anything like that, exacerbated by the six attempts the midwife took to get bloods from me following a miscarriage last spring. She went and found the anaesthetist who got the venflon in painlessly and blood out, but unfortunately in a vein right on the side of my hand, below my thumb, which made moving my hand very difficult. I also hadn't reckoned on being so scared by the drip that I kept threatening to cut my arm off and leave it elsewhere! I then had a mobile telemetry thing attached (standard practice with a syntocinon drip and I suppose I should be glad it was a mobile one, at my local hospital I'd have been stuck on a bed) and I was off. It was about 11.40am by this time. Unfortunately I felt like Frankenstein, with a drip in my hand, a drip stand to drag around, a telemetry monitor thing round my neck and a TENS machine in my other hand - hardly the free moving labour I'd had last time. I managed to knock the drip out the first time I went to the loo as well, which didn't help my squeamishness.
I wandered round the room feeling sorry for myself and trying to work out what was going to make me comfortable. Lynn gathered up some pillows and a bean bag and placed them on the bed so I had something to lean into as I stood. The contractions picked up quite quickly and as they increased I found the TENS was an irritation not a help, partly because unlike last time the pain was low down at the front of my bump as opposed to my back, and also because it was a different, digital machine which was useless and far too complicated!
I asked Keith to take it off, telling them I wanted to use the entonox but concerned that if I did, I could be using my only coping strategy too soon. However I felt so trapped and miserable in that charmless room that I really wanted to take myself out of the situation and knew that the entonox would do that (terrible confession!) so when I realised the contractions were definitely getting harder to deal with, Lynn passed me the mouthpiece.
Laura brought in tea for everyone which was heavenly, I would grab a slurp in between contractions and it was delicious! The entonox was really helping and I was astounded when Lynn turned the drip down - she said that as the contractions were at 4:10 that was as much as we'd want and I remember joking that I wished there'd been someone to turn down the contractions in my first labour, when they just tumbled one on top of the other with no respite. I was still reasonably lucid in between contractions at this point although not for long - although they were reasonably spaced, the intensity was definitely picking up and I was trying to visualise them opening the cervix rather than just being painful.
I could feel I was starting to make a slight noise with each out breath and thought 'not long then, I can cope with this...' Around about then, Lynn took the drip off altogether, and although I was by this point in a non-verbal 'entonox world' I could hear her explaining to Keith that there was no need for it now as my body had taken over. The last part of first stage seemed to go on forever; I demanded 'trousers off!' as I could feel I was starting to push ever so slightly. The belts of the monitor were really starting to hurt, so I tried tugging them off myself, then felt Lynn reaching round and unfastening them which was wonderful. What was interesting was that having had such a fluid, free moving water birth last time I found it carried over into this labour and I found myself arching my back, standing on tiptoes, lifting one leg up, leaning sideways, backwards, forwards, squatting, leaning over the bed, all obviously moving the baby down but it wasn't a conscious choice to move in that way.
Suddenly it all became unbearable; contractions were one on top of the other and I was really dragging on the entonox and I could hear both Lynn and Keith saying 'that's it, don't forget to take a breath when the contraction is over' but as soon as one was almost finished another would hit and there was no time - apparently transition lasted a very long time, about 25 minutes and I didn't remove the mouthpiece once! I can remember trying to, but I just couldn't get a second when I wasn't dealing with a contraction and I was really cross because they were drinking another cup of tea by this point and I could see mine but not touch it.
The funniest part in hindsight was when one part of my head was saying 'nearly there' and the other was adamant I couldn't do it - I stood up about three times, put the mouthpiece down and said 'I CAN'T do this, I'm going home. I've had enough'. I then demanded 'proper drugs' if I was staying, Lynn saying 'what kind of drugs, Rachael?' and me demanding 'diamorphine - heroin - an epidural...something that will actually work'(!). I remember hearing the amusement in Lynn and Keith's voices, and a conversation about transition and Verity's labour and realised I was nearly there. Of course if you were to ask the others what the funniest part of labour was, it would be my animal noises - apparently having done stranded moose in my last labour, I decided to expand on it this time and worked through cow, moose, sheep and various other farm animals! As I've told Keith though, when he's done labour for himself he can comment on noise making in labour...
Laura came in at that point and there was a brief conversation about more antibiotics with Lynn saying no, then they were all sounding pleased because they had managed to avoid having the paediatrician in the room for the birth. (Standard protocol if there's been meconium in the waters apparently).
The urge to push hit me really fast as usual and I found myself squatting with Keith holding up my - not inconsiderable - weight. I could feel the head coming down as I pushed and it seemed to be coming fast - I thought 'thank god this is nearly over' and kept a hand on his head, instinctively stopping him from coming out too fast. When the head came out, Lynn and Keith had swapped places and she was behind me I felt a pause, the head turn and then with one last push and slither he fell out, grey and covered in meconium with the cord round his neck. There was virtually no amniotic fluid. Lynn laid him over her arm and rubbed him with a towel then encouraged me to do the same. I then felt a sting and realised Laura had given me an injection of syntometrine and thought 'there goes nothing, even my 3rd stage isn't what I wanted'. I know that after an induced labour it's normal, but it just felt like the final insult. Lynn said afterwards that she'd intended for me to go ahead with a physiological 3rd stage, as the second half of labour had happened under my own steam and not due to the drip.
I felt like I'd been hit by a truck. Once I'd drunk about 1.5 litres of apple juice and eaten some toast I felt a bit better, by that time the baby was having a feed. I still didn't feel particularly bonded with him, I felt completely spaced out and as if I'd been beaten up - I remember telling everyone that Keith could book in for his vasectomy right then cause there was no effing way I was doing that again! Lynn and Keith wrapped Jude up and took him to Special Care to be checked by the paed (proving that I wasn't myself at all, I can't believe I just sat there and said 'you take him, I'll just have a rest' when normally you can't prise me apart from my babies) and I sat on the chair, sent some text messages and dozed for ten minutes.
When they got back we discussed whether to go straight home or stay in overnight so he could be observed 4 hourly (again, standard practice for meconium apparently). Having discussed the pros and cons, I decided I'd stay in overnight - even though it was unlikely there'd be a problem, if we did have a concern over the baby in the night we'd have had to wake the children, bundle everyone in the car and drive for 35 minutes to the hospital. I felt confident he'd be fine but it just seemed easier, especially as I could get a room, to just stay in and make a rapid escape the next morning by which time any infection would have shown itself if it was going to. Lynn and Keith got me settled in (room had a bathroom attached and was pretty good by hospital standards) and we tried desperately to agree on a name for the baby. None of the names we'd chosen seemed to fit him and I was too tired to mind, so in the end Keith suggested Jude which had been our choice for Verity, always one of my favourite boy names and one he always swore he'd never consider!
Over the next few hours I cuddled and fed Jude and just enjoyed my time with him, which really helped me to recover, although after a few hours in that room I was desperate to get home. Jude did a couple of fairly large vomits which had quite a bit of meconium in them during the night and had lots of feeds and cuddles. The next day Keith arrived with both children and had to chase up the paed and midwife so we could escape, later than planned at about 1pm. It was so lovely to get him home to our house, although I felt a real pang of sadness when I saw my pool liner lying on the grass outside and all my various aromatherapy oils and birth ball lying around.
We've had a lovely babymoon as Keith has 3 weeks off work; I spent the whole first week in my pyjamas being pampered and cuddling my gorgeous new baby. The children seem to have accepted their new brother very easily and life with three children is wonderful...so wonderful that we think we might just have one more just to even up the numbers a bit, so it's lucky Keith didn't rush off and have that vasectomy!
****
I have spent a lot of time de-briefing with Lynn since giving birth to Jude, and writing this birth story proved harder than I thought it would initially. With hindsight, we wondered if something went wrong at around 33 weeks which is when I started feeling very negative and found myself packing a bag 'just in case'. At that time, Lynn said that she noticed Jude's growth slowed, not in a worrying way, but enough that she commented to me that the baby wasn't going to be as big as Archie (who was 9lb 4oz). When Jude was then born with virtually no fluid and covered in meconium it was fairly clear that something just wasn't right. As Lynn said, old meconium in a pre-term baby isn't normal, and he was clearly not happy inside, which is we think why labour started earlier and why he passed meconium a couple of times in the time between my waters breaking and him being born.
As to why labour didn't really get started, even when his head was deeply engaged after I'd been for walks, done side stepping up and down the stairs and bounced on my birth ball, we don't really know. I suppose we could have left things as they were and waited but with him passing meconium I don't think any of us were comfortable, even if his heart rate was fine on the doppler. I think instinct is vitally important in pregnancy and by the time we agreed to transfer I was confident that we were doing the right thing, even though it was a very upsetting decision to make.
What is comforting is that Lynn tells me that as transfers go, we did pretty well out of it - we managed to end up working alongside a hospital midwife who wanted to avoid the interference of doctors and who left Lynn, Keith and I to get on with things our own way. We worked around the hospital protocols and managed to achieve an active birth with only entonox which I never thought I'd manage considering we'd had a syntocinon drip. Personally I think a 3g dose of antibiotics is excessive, given that it's the amount normally given in a week but I haven't done enough research yet to be sure I'm justified in thinking that (although I will be doing it!). I have to say I'll never look back on the actual birth as a lovely experience, although I keep reminding myself that given that I transferred thinking I was going to have a caesarian it wasn't as bad as it could have been, but it was just so hard being in such an unnatural situation. I think it's re-affirmed for us that hospital is somewhere you go when things go wrong, and that for us birth is something private which should take place in the comfort of your own home.
On the positive side, Lynn was absolutely wonderful and I feel privileged to have had her as my midwife. She supported us brilliantly, was great at outlining our options and allowing us to make choices for ourselves and made a difficult experience in hospital far, far better than it would have been otherwise. I can't bear the thought of her not coming in every few days to see us all - so I'll just have to have another baby next year!
Oh btw - first stage was recorded as 3 hours 15 minutes, second stage 6 minutes, and third stage 5 minutes with 100ml blood loss.
Rachael
Rachael @ homebirthsite.littleself.co.uk
(remove 'homebirthsite' to get the real email address)
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